动态心电图对心房颤动合并长R-R间歇的临床分析

目的探讨动态心电图对分析心房颤动合并长R,R间歇（≥1．5秒）、逸搏及逸搏心律出现的时间是否与睡眠有关。方法将人选病例分为睡眠相关组和睡眠无关组进行观察。采用动态心电图连续监测24小时心电图,据患者记录的生活日志,分析长R—R间歇、逸搏及逸搏心律出现的时间。结果睡眠相关组85例患者中发生长R—R间歇1．5～2．0秒,〉2．0秒逸搏及逸搏心律人平均数分别为：（25．72±7．90）次／分钟、（7．30±0．99）次／分钟和（6．83±1．25）次／分钟;睡眠无关组35例患者分别为：（203．20±40．84）次／分钟、（35．14±7．59）次／分钟、（27．80±6．19）次／分钟。睡眠无关组明显高于睡眠相关组（P〈0．01）,风心病患者R—R间歇〉2．0秒,逸搏及逸搏心律频度明显高于其它病种（P〈0．01）。结论心房颤动伴长R—R间歇,逸搏及逸搏心律与睡眠相关时,多与迷走神经张力增高有关;而与睡眠无关时,应考虑病理性房室阻滞。风心病持续房颤由于使用洋地黄及β-受体阻滞剂易于出现长间歇。

Analysis of atrial fibrillation with long R-R interval on dynamic electrocardiography

Objective To investigate whether or not pathological atrio-ventricular blocks exist in atrial fibrillation complicated by long RR interval （≥1.5 s） ,escape beats or escape rhythm on dynamic electrocardiogram. Methods Subjects were divided into sleep-related group （group A） and non-sleep-related group （ group B） based on the relationship between episodes pattern of long RR interval, escape beats or escape rhythm and sleep recorded by dynamic electrocardiogram and the subjects＇ diary. Results The average number of episodes with RR interval of I. 5 to 2.0 s, longer than 2.0 s, escape beats or escape rhythm was 25.72 ± 7.90,7.30 ± 0.99,6.83 ± 1.25 per person, respectively ; whereas in group B, the number was 203.20 ± 40.84,35.14 ± 7.59,27.8 ± 6.19, respectively. Episodes occurred more significantly in group B than those in group A（P 〈0.01 ） culprit coronary arteries were 54.9% ,61.5% and 91.4% respectively（ P 〈 0.05 ）. Conclusions Atrial fibrillation complicated by long RR interval, escape beats or escape rhythm is a physiological block phenomenon when related to sleep,whereas a pathological one when not related to sleep.